|
Poisoning Of Medicinal Agents
|
Facility
|
IP
|
$9,939.54
|
|
|
Service Code
|
APR-DRG 8124
|
| Hospital Charge Code |
APRDRG8123
|
| Min. Negotiated Rate |
$9,939.54 |
| Max. Negotiated Rate |
$9,939.54 |
| Rate for Payer: AHCCCS Medicaid |
$9,939.54
|
| Rate for Payer: Allwell Medicaid |
$9,939.54
|
| Rate for Payer: AZCH Complete Medicaid |
$9,939.54
|
| Rate for Payer: Banner UC Health Medicaid |
$9,939.54
|
| Rate for Payer: Mercy Care Medicaid |
$9,939.54
|
|
|
Poisoning Of Medicinal Agents
|
Facility
|
IP
|
$2,564.32
|
|
|
Service Code
|
APR-DRG 8121
|
| Hospital Charge Code |
APRDRG8123
|
| Min. Negotiated Rate |
$2,564.32 |
| Max. Negotiated Rate |
$2,564.32 |
| Rate for Payer: AHCCCS Medicaid |
$2,564.32
|
| Rate for Payer: Allwell Medicaid |
$2,564.32
|
| Rate for Payer: AZCH Complete Medicaid |
$2,564.32
|
| Rate for Payer: Banner UC Health Medicaid |
$2,564.32
|
| Rate for Payer: Mercy Care Medicaid |
$2,564.32
|
|
|
Poisoning Of Medicinal Agents
|
Facility
|
IP
|
$5,178.44
|
|
|
Service Code
|
APR-DRG 8123
|
| Hospital Charge Code |
APRDRG8124
|
| Min. Negotiated Rate |
$5,178.44 |
| Max. Negotiated Rate |
$5,178.44 |
| Rate for Payer: AHCCCS Medicaid |
$5,178.44
|
| Rate for Payer: Allwell Medicaid |
$5,178.44
|
| Rate for Payer: AZCH Complete Medicaid |
$5,178.44
|
| Rate for Payer: Banner UC Health Medicaid |
$5,178.44
|
| Rate for Payer: Mercy Care Medicaid |
$5,178.44
|
|
|
Poisoning Of Medicinal Agents
|
Facility
|
IP
|
$3,462.81
|
|
|
Service Code
|
APR-DRG 8122
|
| Hospital Charge Code |
APRDRG8124
|
| Min. Negotiated Rate |
$3,462.81 |
| Max. Negotiated Rate |
$3,462.81 |
| Rate for Payer: AHCCCS Medicaid |
$3,462.81
|
| Rate for Payer: Allwell Medicaid |
$3,462.81
|
| Rate for Payer: AZCH Complete Medicaid |
$3,462.81
|
| Rate for Payer: Banner UC Health Medicaid |
$3,462.81
|
| Rate for Payer: Mercy Care Medicaid |
$3,462.81
|
|
|
Poisoning Of Medicinal Agents
|
Facility
|
IP
|
$2,564.32
|
|
|
Service Code
|
APR-DRG 8121
|
| Hospital Charge Code |
APRDRG8122
|
| Min. Negotiated Rate |
$2,564.32 |
| Max. Negotiated Rate |
$2,564.32 |
| Rate for Payer: AHCCCS Medicaid |
$2,564.32
|
| Rate for Payer: Allwell Medicaid |
$2,564.32
|
| Rate for Payer: AZCH Complete Medicaid |
$2,564.32
|
| Rate for Payer: Banner UC Health Medicaid |
$2,564.32
|
| Rate for Payer: Mercy Care Medicaid |
$2,564.32
|
|
|
Poisoning Of Medicinal Agents
|
Facility
|
IP
|
$3,462.81
|
|
|
Service Code
|
APR-DRG 8122
|
| Hospital Charge Code |
APRDRG8121
|
| Min. Negotiated Rate |
$3,462.81 |
| Max. Negotiated Rate |
$3,462.81 |
| Rate for Payer: AHCCCS Medicaid |
$3,462.81
|
| Rate for Payer: Allwell Medicaid |
$3,462.81
|
| Rate for Payer: AZCH Complete Medicaid |
$3,462.81
|
| Rate for Payer: Banner UC Health Medicaid |
$3,462.81
|
| Rate for Payer: Mercy Care Medicaid |
$3,462.81
|
|
|
Poisoning Of Medicinal Agents
|
Facility
|
IP
|
$3,462.81
|
|
|
Service Code
|
APR-DRG 8122
|
| Hospital Charge Code |
APRDRG8123
|
| Min. Negotiated Rate |
$3,462.81 |
| Max. Negotiated Rate |
$3,462.81 |
| Rate for Payer: AHCCCS Medicaid |
$3,462.81
|
| Rate for Payer: Allwell Medicaid |
$3,462.81
|
| Rate for Payer: AZCH Complete Medicaid |
$3,462.81
|
| Rate for Payer: Banner UC Health Medicaid |
$3,462.81
|
| Rate for Payer: Mercy Care Medicaid |
$3,462.81
|
|
|
polyethylene glycol 3350 17 GmOral Pwdr [CQCH]
|
Facility
|
OP
|
$0.87
|
|
|
Service Code
|
NDC 11523726803
|
| Hospital Charge Code |
105964541
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.78 |
| Rate for Payer: Aetna of AZ Commercial |
$0.78
|
| Rate for Payer: Aetna of AZ Medicare |
$0.24
|
| Rate for Payer: Allwell Medicare |
$0.13
|
| Rate for Payer: Amerigroup Medicare |
$0.13
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.32
|
| Rate for Payer: AZCH Complete Medicare |
$0.13
|
| Rate for Payer: Banner UC Health Medicare |
$0.13
|
| Rate for Payer: Bisbee Police All Plans |
$0.23
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.59
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Cigna of AZ Commercial |
$0.57
|
| Rate for Payer: Copperpoint Commercial |
$0.22
|
| Rate for Payer: Health Net of AZ Commercial |
$0.52
|
| Rate for Payer: Health Net of AZ Medicare |
$0.24
|
| Rate for Payer: Humana of AZ Medicare |
$0.13
|
| Rate for Payer: Self Pay Self Pay |
$0.70
|
| Rate for Payer: TriWest Medicare |
$0.13
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.51
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.16
|
|
|
polyethylene glycol 3350 17 GmOral Pwdr [CQCH]
|
Facility
|
IP
|
$0.87
|
|
|
Service Code
|
NDC 11523726803
|
| Hospital Charge Code |
105964541
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.78 |
| Rate for Payer: Aetna of AZ Commercial |
$0.78
|
| Rate for Payer: Bisbee Police All Plans |
$0.23
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Self Pay Self Pay |
$0.70
|
|
|
polyethylene glycol 3350 Oral Pwdr (GaviLyte-C) for Sol 4000 mL [CQCH]
|
Facility
|
OP
|
$22.01
|
|
|
Service Code
|
NDC 43386006019
|
| Hospital Charge Code |
105937171
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$19.81 |
| Rate for Payer: Aetna of AZ Commercial |
$19.81
|
| Rate for Payer: Aetna of AZ Medicare |
$6.16
|
| Rate for Payer: Allwell Medicare |
$3.30
|
| Rate for Payer: Amerigroup Medicare |
$3.30
|
| Rate for Payer: APIPA Medicare/Medicaid |
$8.22
|
| Rate for Payer: AZCH Complete Medicare |
$3.30
|
| Rate for Payer: Banner UC Health Medicare |
$3.30
|
| Rate for Payer: Bisbee Police All Plans |
$5.72
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$14.97
|
| Rate for Payer: Cash Price |
$17.61
|
| Rate for Payer: Cigna of AZ Commercial |
$14.31
|
| Rate for Payer: Copperpoint Commercial |
$5.45
|
| Rate for Payer: Health Net of AZ Commercial |
$13.21
|
| Rate for Payer: Health Net of AZ Medicare |
$6.16
|
| Rate for Payer: Humana of AZ Medicare |
$3.30
|
| Rate for Payer: Self Pay Self Pay |
$17.61
|
| Rate for Payer: TriWest Medicare |
$3.30
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$12.83
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$3.96
|
|
|
polyethylene glycol 3350 Oral Pwdr (GaviLyte-C) for Sol 4000 mL [CQCH]
|
Facility
|
IP
|
$22.01
|
|
|
Service Code
|
NDC 43386006019
|
| Hospital Charge Code |
105937171
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$19.81 |
| Rate for Payer: Aetna of AZ Commercial |
$19.81
|
| Rate for Payer: Bisbee Police All Plans |
$5.72
|
| Rate for Payer: Cash Price |
$17.61
|
| Rate for Payer: Self Pay Self Pay |
$17.61
|
|
|
polyethylene glycol 3350 - REC[CQCH]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 11523723403
|
| Hospital Charge Code |
168068958
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of AZ Commercial |
$0.04
|
| Rate for Payer: Bisbee Police All Plans |
$0.01
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Self Pay Self Pay |
$0.03
|
|
|
polyethylene glycol 3350 - REC[CQCH]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 11523723403
|
| Hospital Charge Code |
168068958
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of AZ Commercial |
$0.04
|
| Rate for Payer: Aetna of AZ Medicare |
$0.01
|
| Rate for Payer: Allwell Medicare |
$0.01
|
| Rate for Payer: Amerigroup Medicare |
$0.01
|
| Rate for Payer: APIPA Medicare/Medicaid |
$0.01
|
| Rate for Payer: AZCH Complete Medicare |
$0.01
|
| Rate for Payer: Banner UC Health Medicare |
$0.01
|
| Rate for Payer: Bisbee Police All Plans |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of AZ Commercial |
$0.03
|
| Rate for Payer: Copperpoint Commercial |
$0.01
|
| Rate for Payer: Health Net of AZ Commercial |
$0.02
|
| Rate for Payer: Health Net of AZ Medicare |
$0.01
|
| Rate for Payer: Humana of AZ Medicare |
$0.01
|
| Rate for Payer: Self Pay Self Pay |
$0.03
|
| Rate for Payer: TriWest Medicare |
$0.01
|
| Rate for Payer: UnitedHealth Group of AZ Commercial |
$0.02
|
| Rate for Payer: UnitedHealth Group of AZ Medicare |
$0.01
|
|
|
Post-Operative, Post-Trauma, Other Device Infections With O.R. Procedure
|
Facility
|
IP
|
$7,152.88
|
|
|
Service Code
|
APR-DRG 7111
|
| Hospital Charge Code |
APRDRG7112
|
| Min. Negotiated Rate |
$7,152.88 |
| Max. Negotiated Rate |
$7,152.88 |
| Rate for Payer: AHCCCS Medicaid |
$7,152.88
|
| Rate for Payer: Allwell Medicaid |
$7,152.88
|
| Rate for Payer: AZCH Complete Medicaid |
$7,152.88
|
| Rate for Payer: Banner UC Health Medicaid |
$7,152.88
|
| Rate for Payer: Mercy Care Medicaid |
$7,152.88
|
|
|
Post-Operative, Post-Trauma, Other Device Infections With O.R. Procedure
|
Facility
|
IP
|
$9,573.41
|
|
|
Service Code
|
APR-DRG 7112
|
| Hospital Charge Code |
APRDRG7114
|
| Min. Negotiated Rate |
$9,573.41 |
| Max. Negotiated Rate |
$9,573.41 |
| Rate for Payer: AHCCCS Medicaid |
$9,573.41
|
| Rate for Payer: Allwell Medicaid |
$9,573.41
|
| Rate for Payer: AZCH Complete Medicaid |
$9,573.41
|
| Rate for Payer: Banner UC Health Medicaid |
$9,573.41
|
| Rate for Payer: Mercy Care Medicaid |
$9,573.41
|
|
|
Post-Operative, Post-Trauma, Other Device Infections With O.R. Procedure
|
Facility
|
IP
|
$7,152.88
|
|
|
Service Code
|
APR-DRG 7111
|
| Hospital Charge Code |
APRDRG7113
|
| Min. Negotiated Rate |
$7,152.88 |
| Max. Negotiated Rate |
$7,152.88 |
| Rate for Payer: AHCCCS Medicaid |
$7,152.88
|
| Rate for Payer: Allwell Medicaid |
$7,152.88
|
| Rate for Payer: AZCH Complete Medicaid |
$7,152.88
|
| Rate for Payer: Banner UC Health Medicaid |
$7,152.88
|
| Rate for Payer: Mercy Care Medicaid |
$7,152.88
|
|
|
Post-Operative, Post-Trauma, Other Device Infections With O.R. Procedure
|
Facility
|
IP
|
$33,120.81
|
|
|
Service Code
|
APR-DRG 7114
|
| Hospital Charge Code |
APRDRG7114
|
| Min. Negotiated Rate |
$33,120.81 |
| Max. Negotiated Rate |
$33,120.81 |
| Rate for Payer: AHCCCS Medicaid |
$33,120.81
|
| Rate for Payer: Allwell Medicaid |
$33,120.81
|
| Rate for Payer: AZCH Complete Medicaid |
$33,120.81
|
| Rate for Payer: Banner UC Health Medicaid |
$33,120.81
|
| Rate for Payer: Mercy Care Medicaid |
$33,120.81
|
|
|
Post-Operative, Post-Trauma, Other Device Infections With O.R. Procedure
|
Facility
|
IP
|
$7,152.88
|
|
|
Service Code
|
APR-DRG 7111
|
| Hospital Charge Code |
APRDRG7114
|
| Min. Negotiated Rate |
$7,152.88 |
| Max. Negotiated Rate |
$7,152.88 |
| Rate for Payer: AHCCCS Medicaid |
$7,152.88
|
| Rate for Payer: Allwell Medicaid |
$7,152.88
|
| Rate for Payer: AZCH Complete Medicaid |
$7,152.88
|
| Rate for Payer: Banner UC Health Medicaid |
$7,152.88
|
| Rate for Payer: Mercy Care Medicaid |
$7,152.88
|
|
|
Post-Operative, Post-Trauma, Other Device Infections With O.R. Procedure
|
Facility
|
IP
|
$33,120.81
|
|
|
Service Code
|
APR-DRG 7114
|
| Hospital Charge Code |
APRDRG7111
|
| Min. Negotiated Rate |
$33,120.81 |
| Max. Negotiated Rate |
$33,120.81 |
| Rate for Payer: AHCCCS Medicaid |
$33,120.81
|
| Rate for Payer: Allwell Medicaid |
$33,120.81
|
| Rate for Payer: AZCH Complete Medicaid |
$33,120.81
|
| Rate for Payer: Banner UC Health Medicaid |
$33,120.81
|
| Rate for Payer: Mercy Care Medicaid |
$33,120.81
|
|
|
Post-Operative, Post-Trauma, Other Device Infections With O.R. Procedure
|
Facility
|
IP
|
$9,573.41
|
|
|
Service Code
|
APR-DRG 7112
|
| Hospital Charge Code |
APRDRG7112
|
| Min. Negotiated Rate |
$9,573.41 |
| Max. Negotiated Rate |
$9,573.41 |
| Rate for Payer: AHCCCS Medicaid |
$9,573.41
|
| Rate for Payer: Allwell Medicaid |
$9,573.41
|
| Rate for Payer: AZCH Complete Medicaid |
$9,573.41
|
| Rate for Payer: Banner UC Health Medicaid |
$9,573.41
|
| Rate for Payer: Mercy Care Medicaid |
$9,573.41
|
|
|
Post-Operative, Post-Trauma, Other Device Infections With O.R. Procedure
|
Facility
|
IP
|
$33,120.81
|
|
|
Service Code
|
APR-DRG 7114
|
| Hospital Charge Code |
APRDRG7112
|
| Min. Negotiated Rate |
$33,120.81 |
| Max. Negotiated Rate |
$33,120.81 |
| Rate for Payer: AHCCCS Medicaid |
$33,120.81
|
| Rate for Payer: Allwell Medicaid |
$33,120.81
|
| Rate for Payer: AZCH Complete Medicaid |
$33,120.81
|
| Rate for Payer: Banner UC Health Medicaid |
$33,120.81
|
| Rate for Payer: Mercy Care Medicaid |
$33,120.81
|
|
|
Post-Operative, Post-Trauma, Other Device Infections With O.R. Procedure
|
Facility
|
IP
|
$16,744.52
|
|
|
Service Code
|
APR-DRG 7113
|
| Hospital Charge Code |
APRDRG7114
|
| Min. Negotiated Rate |
$16,744.52 |
| Max. Negotiated Rate |
$16,744.52 |
| Rate for Payer: AHCCCS Medicaid |
$16,744.52
|
| Rate for Payer: Allwell Medicaid |
$16,744.52
|
| Rate for Payer: AZCH Complete Medicaid |
$16,744.52
|
| Rate for Payer: Banner UC Health Medicaid |
$16,744.52
|
| Rate for Payer: Mercy Care Medicaid |
$16,744.52
|
|
|
Post-Operative, Post-Trauma, Other Device Infections With O.R. Procedure
|
Facility
|
IP
|
$16,744.52
|
|
|
Service Code
|
APR-DRG 7113
|
| Hospital Charge Code |
APRDRG7112
|
| Min. Negotiated Rate |
$16,744.52 |
| Max. Negotiated Rate |
$16,744.52 |
| Rate for Payer: AHCCCS Medicaid |
$16,744.52
|
| Rate for Payer: Allwell Medicaid |
$16,744.52
|
| Rate for Payer: AZCH Complete Medicaid |
$16,744.52
|
| Rate for Payer: Banner UC Health Medicaid |
$16,744.52
|
| Rate for Payer: Mercy Care Medicaid |
$16,744.52
|
|
|
Post-Operative, Post-Trauma, Other Device Infections With O.R. Procedure
|
Facility
|
IP
|
$9,573.41
|
|
|
Service Code
|
APR-DRG 7112
|
| Hospital Charge Code |
APRDRG7111
|
| Min. Negotiated Rate |
$9,573.41 |
| Max. Negotiated Rate |
$9,573.41 |
| Rate for Payer: AHCCCS Medicaid |
$9,573.41
|
| Rate for Payer: Allwell Medicaid |
$9,573.41
|
| Rate for Payer: AZCH Complete Medicaid |
$9,573.41
|
| Rate for Payer: Banner UC Health Medicaid |
$9,573.41
|
| Rate for Payer: Mercy Care Medicaid |
$9,573.41
|
|
|
Post-Operative, Post-Trauma, Other Device Infections With O.R. Procedure
|
Facility
|
IP
|
$16,744.52
|
|
|
Service Code
|
APR-DRG 7113
|
| Hospital Charge Code |
APRDRG7113
|
| Min. Negotiated Rate |
$16,744.52 |
| Max. Negotiated Rate |
$16,744.52 |
| Rate for Payer: AHCCCS Medicaid |
$16,744.52
|
| Rate for Payer: Allwell Medicaid |
$16,744.52
|
| Rate for Payer: AZCH Complete Medicaid |
$16,744.52
|
| Rate for Payer: Banner UC Health Medicaid |
$16,744.52
|
| Rate for Payer: Mercy Care Medicaid |
$16,744.52
|
|
